Allergic Rhinitis: How Do I Manage My Weekend Flu?

I have allergic rhinitis. I got it from my father. My sisters and brothers have it too. My elder sister has it so frequently and it is so severe that once she starts sneezing, she continues it for hours.

She has lost her sense of smell because she has had it for so long. My father has been operated on for a hernia five times.

When he sneezes, his abdominal pressure is so high that he frequently develops a hernia at the site of his lower abdomen.

And we don’t sneeze quietly like “achoo”. We sneeze like this “Aaaaachhhhhhhhhhoooooooooo“. If you hear it for the first time, you will be surprised.

I remember my aunt once sneezed so loudly that her husband came out running asking if someone was fighting.

Allergic Rhinitis vs Viral Influenza:

I have flu but it mostly ruins my weekend. I try to avoid taking medicines for it but sometimes I have to as I don’t want to be on my bed on weekends. I call it Weekend Flu.

Weekend Flu is different from Viral Flu or Influenza. Influenza is a viral infection and may lead to pneumonia and respiratory failure.

Allergic Rhinitis vs COVID-19:

Allergic Rhinitis is an ongoing chronic nuisance. It doesn’t affect your lungs and is not contagious. If you have allergic rhinitis, you may lose your sense of smell, like COVID.

However, COVID-19 is a viral infection that can affect your upper and lower respiratory tract.

Thus, you can have COVID-19 infection mimicking allergic rhinitis, or you can have COVID-19 pneumonia.

COVID-19 pneumonia is a serious life-threatening condition and people require hospitalization.

Allergic Rhinitis vs Sinusitis:

Sinusitis and allergic rhinitis can co-exist. Most people who have allergic rhinitis have enlarged turbinates in their nostrils.

These turbinates block your draining outlets of sinuses resulting in the accumulation of secretions in your sinuses.

Most people with chronic sinusitis have a dull aching headache that is especially severe when you bend down such as when you are tying up your laces or picking something up from the floor.

In addition, bacterial and fungal infections of the sinuses are associated with high-grade fever, headache, and purulent secretions from the sinuses.

How Do I Manage My Weekend Flu (Allergic Rhinitis)?

My weekend flu (allergic rhinitis on weekends) does not bother me every weekend. And it’s very unpredictable. But I think it has something to do with emotions and a change of environment.

I have to suppress my weekend flu before it gets started because once I start sneezing then none of the medications and home remedies work.

Anyway, here are some of the things I try to suppress my weekend flu:

• Herbal teas:

Herbal teas have a soothing effect. They can open your nostrils and sinuses. Most herbal teas have peppermint, chamomile, cinnamon, and ginger extracts.

These teas have anti-inflammatory and antioxidant properties and help relieve nasal obstruction. However, some herbal teas contain stimulants which can be bad for people with heart disease.

One of the ingredients that is bad for people with heart diseases, hypertension, anxiety, and thyroid disorders is Ephedrine.

• Antihistamines:

Antihistamines are the mainstay of treatment of allergic rhinitis. These drugs block the histamine (H1) receptors present in the nostrils and inhibit the release of histamine which is responsible for causing runny nose, sneezing, and nasal congestion.

Antihistamines are best when started at the onset of symptoms or before that because once the flu symptoms develop, it takes a while to get relief.

Benadryl (diphenhydramine) is one of the commonly used first-generation antihistamines. It is very effective but has sedative properties. It makes you feel sleepy and is best to take at night.

The second-generation antihistamines are not as sedative as the first-generation antihistamines. For people who have to go to work or drive, the second-generation antihistamines are relatively safer.

Commonly used second-generation antihistamines include:

• Cetrizine vs Loratadine:

Cetrizine and Loratadine are both second-generation antihistamines. However, Cetrizine is more sedating than loratadine.

Cetrizine is rapid-acting and has an onset of action within one hour. Loratadine starts to act within 1 to 3 hours.

The anti-allergic effects of Cetrizine last for more than 24 hours while that of Loratadine is about 22 to 24 hours.

Cetrizine and Loratadine are both “Category B” drugs and can be safely used for symptomatic relief of runny nose and sneezing during pregnancy.

• Loratadine Vs Desloratadine:

Desloratadine is the active compound of loratadine. Hence, it is more potent than Loratadine. In addition, it is considered more specific, less sedative, and safer than loratadine in patients who are on multiple medications and pregnant women.

Because desloratadine is highly specific, it has fewer drug interactions compared to loratadine. 

• Cetrizine Vs Fexofenadine:

Cetrizine and Fexofenadine are both second-generation antihistamines.

Cetrizine has the advantage of rapid onset of action and prolonged duration. It is also considered more effective, especially in patients with chronic idiopathic urticaria, runny nose, and sneezing [Ref].

In addition, Fexofenadine poses the risk of QT-interval prolongation. It is best to use Cetrizine over fexofenadine in patients at risk of cardiac arrhythmias.

Fexofenadine may be suitable for some people who have little relief using Cetrizine. Furthermore, Fexofenadine is less sedative and is best for people who have to drive or during working hours.

Fexofenadine is more costly than Cetrizine. Both can be used during pregnancy.

• Fexofenadine vs Loratadine:

Fexofenadine and loratadine are both second-generation antihistamines. Both are considered less sedative compared to Benadryl and cetirizine.

Fexofenadine is considered more effective than Loratadine in relieving symptoms of allergic rhinitis.

However, Loratadine is safer in patients who are at risk of cardiac arrhythmias as it does not significantly increase the QT interval.

• Ebastine vs other antihistamines:

Ebastine is a second-generation antihistamine. It is less sedative than Cetrizine but has a slower onset of action.

Compared to Cetrizine, it is longer acting, requiring once-daily dosing.

Ebasatine can be taken with or without meals, unlike Fexofenadine which is best to be taken on an empty stomach.

Ebastine, like Fexofenadine, can also prolong QT interval and should be avoided in patients who are at risk of QT interval prolongation.

• Antihistamine Vs Monteleuast:

Antihistamines are primarily used to treat symptoms of allergic rhinitis. Montelukast is commonly used to treat asthma and symptoms of lower airways.

For rapid relief of symptoms, antihistamines are preferred and more effective in relieving the symptoms of allergic rhinitis.

However, some patients have an inadequate response and severe night-time symptoms. These patients can benefit from the combined use of antihistamines and montelukast together.

Monteleukast is non-sedative but it takes a few days to exert its effects. In addition, it may be best for people who have associated allergic bronchitis or asthma along with allergic rhinitis.

• Nasal Sprays:

Nasal sprays are very commonly used to treat nasal blockage. They have a very rapid onset of action when used for symptomatic relief. 

Most nasal sprays contain decongestants and corticosteroids. Some are used for rapid relief while others are used for long-term maintenance treatment. 

Here is a list of the nasal sprays that are commonly used to treat allergic rhinitis:

• Decongestants:

Xylometazoline and oxymetazoline are the active components of decongestant nasal sprays. They have a rapid onset of action within minutes). 

However, prolonged use should be avoided as they can cause rebound symptoms (rhinitis medicamentosa).

Afrin, Xynosine, Dristan, and Zicam are the commonly available brands.

• Antihistamines:

Azelastine is the active ingredient of these sprays, available as Asteline and Astepro).

They are less effective than decongestants and corticosteroid nasal sprays but safer alternatives for people who wish to avoid taking oral antihistamines.

• Corticosteroids:

The major component of most nasal sprays is topical corticosteroids. Some of the common corticosteroid nasal sprays are:

• Mometasone (Nasonex): It is a potent topical corticosteroid and is a prescription-only nasal spray. It is indicated for long-term treatment of allergic rhinitis.
• Fluticasone (Flixonase, Flonase): It is available over the counter and best for long-term treatment of allergic rhinitis.
• Budesonide, Triamcinolone, and Beclomethasone (Rinoclenil): These are safer choices for use in children. Budesonide can also be used during pregnancy.

How do I treat my allergic rhinitis?

I take an antihistamine, typically Loratadine which is non-sedative and cheaper. Cetrizine has a rapid onset of action and is more effective but it makes me drowsy.

Some people tolerate Cetrizine very well. Ebastine and fexofenadine are more costly and not readily available.

In addition, for a stuffy nose, I don’t like using decongestant nasal sprays as these sprays can cause dependence.

I prefer Rhinosone nasal spray for rapid relief and Flixonase for long-term treatment when I think my symptoms are more frequent.

The active ingredients of this spray are:

• Naphazoline, a decongestant,
• Ephedrine, a decongestant, and 
• Prednisolone, a corticosteroid

Flixonase (Fluticasone) is a potent topical corticosteroid. I use it for long-term treatment of allergic rhinitis when I feel my symptoms are recurrent and more frequent.

It is costly but has a better smell (like a rose flower) and is easy to use.

I don’t need to take monteleukast and I have tried topical Azelastine nasal spray but I have not found them effective.

In Summary:

Allergic Rhinitis manifests as runny nose or stuffy nose, flu, and sneezing. It usually runs in families and it can cause loss of smell.

It can coexist or can be triggered by viral infections such as influenza, COVID-19 infection, allergic bronchitis, and Asthma.

Treatment is supportive in the form of antihistamines, nasal sprays, and decongestants. 

I prefer Loratadine or Cetrizine and decongestant + corticosteroid nasal spray to treat myself.